Billing and Coding: Genetic Testing for Oncology

Covered tests: genetic oncology testing is covered only when the billed CPT code and listed gene(s) directly match the specific medical condition and documented disease per LCD L39367; tests or coding that do not meet the LCD’s reasonable/necessary criteria are excluded. Key requirements: follow the AMA CPT Codebook and Medicare NCCI rules, use the most specific molecular CPT codes that reflect the exact genes/elements tested, technology and specimen, and ensure all billed genes fall within the CPT code’s condition description.